in population of home health care workers by: estimating the incidence of exposures to blood and IThe objective of the proposed study is to evaluate the risks of exposure to blood and sharps injury a large percutaneous injuries; identifying and evaluating risk factors associated with these exposures; and assessing the availability and use of medical safety devices. The proposed study will be conducted by a multi- disciplinary team working with 3 large home health care agencies and 2 health care labor unions. The partner agencies and unions deliver most of the home health care in eastern Massachusetts. This 4-year study is divided into 5 specific aims. In aim 1, a surveillance system for blood exposure and sharps injuries (exposure/injury) will be established in the 3 partner home care agencies. Two years of surveillance data will be gathered. In Aim 2, surveys will be conducted of home health care workers (HHCW) to gather data on exposure/injury, under-reporting, and availability and use of medical safety devices. A first, longer survey will be conducted in year 1, while a second, shorter survey will be conducted in years 3 and 4, after the surveillance system has been functioning for at least 1 year. Aim 3 will use qualitative research methods to identify institutional barriers and incentives to exposure/injury reporting and the availability and use of medical safety devices. Aim 4 consists of the quantitative analytic methods for studying the data gathered in the surveillance and risk factor surveys. Aim 5 describes methods for communication of the findings and the development of training to the partner agencies/unions as well as dissemination of the study results to the broader home health care industry and the scientific community. This work will assist home health care agencies, unions, professional organizations, and government agencies by providing information that can aid in reducing blood exposure and sharps injury.